When and for whom?This is a procedure whose indication is chronic severe arthritic pain (as with other joint replacements). How much pain and for how long ? are open to debate. It is not a 'prophylactic' procedure to prevent the occurence of severe symptoms . The progression of an arthritic ankle is often unpredictable. Generally patients should be over the age of fifty. This relates to probable higher functional requirements in the younger age group and as a result likely reduced longevity of the joint. The age of fifty is not an absolute figure. As important as age are the functional requirements of any patient. Those in 'heavy manual' occupations (builders, farmers, heavy industry workers) who are over fifty are probably better advised going for an ankle fusion especially if they have isolated ankle arthritis.

Are there any other benefits except loss of pain?Improving the RANGE of movement per se is not an indication, though may occur. The pre-operative range is probably maintained. Improved MOBILITY is possible, as a result of the pain free joint.

Why fifty, why not younger?This age is not an absolute lower limit. The good evidence on longevity of ankle replacements mainly relates to patients over this age. It is likely that, as with other joint replacements, in younger and more active patients an ankle replacement will not last as long as the quoted figures. An exception to this would be a younger patient with multiple arthritic joints (such as with severe rheumatoid disease) who is likely to have low functional requirements.

Alternatives to replacementThe most common operative alternative is an ankle fusionfor severe arthritic symptoms. However other options do exist such as arthroscopic debridement and Ilizarov joint distraction (see ankle arthritis, other options).